Elevated serum creatinine or urea in paediatric patients

​​​Emergency

If any of the following are suspected, please seek emergency medical advice or refer the patient to the emergency department (via ambulance if necessary):

  • Serum creatinine > 2 times above normal range for age and any one of the following features: 
    • Elevated creatine kinase 
    • Hypertension (i.e. blood pressure > 95th centile for age and height)
      Note: refer to the American Academy of Pediatrics 2017 guideline​
    • Low urine output
    • Serum potassium above normal range 
    • Significant peripheral oedema (e.g. scrotal oedema, ascites, pleural effusions)
    • Signs of pulmonary oedema 
    • Systemically unwell 

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • Previously diagnosed chronic kidney disease stage 3-5​​​​

  • Serum creatinine up to 2 times above normal range for age on > 2 occasions and any of the following features:

    • Electrolyte disturbance
    • Faltering growth
    • Metabolic acidosis
    • Microscopic haematuria
    • Proteinuria
    • Rickets
    • Unexplained anaemia

Category 2
Recommended to be seen within 90 calendar days.

  • Previously diagnosed chronic kidney disease stage 1-2 who require ongoing specialist follow up
  • Elevated serum creatinine on > 2 occasions and family history of chronic kidney disease in a 1st degree relative, if otherwise not listed in Category 1
  • Elevated serum creatinine in an Aboriginal and/or
    Torres Strait Islander person, if otherwise not listed in Category 1
  • Serum creatinine up to 2 times above normal range for age on > 2 occasions without features listed in
    Category 1

Information to include within a referral

Required

  • Reason for referral
  • Provisional diagnosis
  • Details of the presenting condition, including symptoms and their duration, and impact on activities of daily living and school attendance
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • Perinatal history, including birth weight (where available)
    • Developmental history
    • History of supplement or over-the-counter medication use
    • Serial blood pressure measurements (where available)
    • Growth parameters
    • Renal ultrasound
    • Pathology:
      • Calcium, magnesium, phosphate (CMP)
      • Full blood count (FBC)
      • Liver function test (LFT)
      • Urea, electrolytes, creatinine (UEC)
      • Urinalysis or M/C/S results
      • Urine Protein-to-Creatinine Ratio (UPCR)

If available

  • Family history of any kidney disease

  • Other available blood results

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.


 

Current as at: Thursday 10 September 2026
Contact page owner: System Purchasing